What does this research mean for the field?

Low preoperative hemoglobin levels (8-12 g/dL) increase the incidence of postoperative atrial fibrillation and flutter by 44% compared to higher levels (>12 g/dL). Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

This study aims to determine the relationship between preoperative hemoglobin levels and the risk of postoperative atrial fibrillation and flutter after total joint arthroplasty.

January 10, 2026Scientific Reports0 citationsOpen Access

Preoperative hemoglobin level and risk of new-onset atrial fibrillation and flutter after total joint arthroplasty: a retrospective analysis

YLYi-Chen Lai TYTing-Sian YuE-Da Hospital KHKuo-Chuan HungNational Sun Yat-sen University

Key Result

Low preoperative hemoglobin levels (8-12 g/dL) increased six-month postoperative atrial fibrillation incidence by 44% (HR 1.39) compared to higher levels (>12 g/dL).

Key Points

This study aims to determine the relationship between preoperative hemoglobin levels and the risk of postoperative atrial fibrillation and flutter after total joint arthroplasty.
Used a retrospective cohort design analyzing patients aged ≥ 40 undergoing elective knee or hip arthroplasty.
Categorized patients into low hemoglobin and control groups based on preoperative hemoglobin levels.
Employed 1:1 propensity score matching to compare outcomes between groups.
Applied Cox regression analysis to assess postoperative atrial fibrillation incidence and other critical outcomes.
Significantly higher six-month incidence of postoperative atrial fibrillation in the low hemoglobin group (1.4% vs. 0.97%).
Increased all-cause mortality in the low hemoglobin group (1.0% vs. 0.47%).
Higher ICU admission rates noted in the low hemoglobin group (1.4% vs. 0.84%).
Even mild reductions in hemoglobin (10-12 g/dL) correlated with elevated postoperative atrial fibrillation risk.

Structured PICO

Does low preoperative hemoglobin increase the risk of new-onset postoperative atrial fibrillation and flutter in patients undergoing elective total joint arthroplasty?

Population

45,992 patients (after 1:1 propensity score matching yielding 22,996 pairs) aged ≥ 40 years undergoing elective primary total knee or hip arthroplasty under general anesthesia between 2010 and 2024. Key exclusions: stage 4 or 5 chronic kidney disease, end-stage renal disease requiring dialysis, pre-existing atrial fibrillation and flutter, stroke, transient ischemic attack, other cardiac arrhythmias, recent sepsis, acute respiratory failure, ICU admission, acute kidney injury, COVID-19 infection within one month, heart transplant, prior cardiac surgery, or pacemaker implantation.

Intervention

Low preoperative hemoglobin (8-12 g/dL) measured within four weeks prior to surgery.

Comparator

Control group with preoperative hemoglobin > 12.0 g/dL, matched 1:1 using propensity scores.

Outcome

New-onset postoperative atrial fibrillation and flutter (POAF) at six-month follow-up.hard clinical

Preoperative anemia (hemoglobin 8-12 g/dL) is an independent risk factor for new-onset postoperative atrial fibrillation and flutter, as well as increased mortality and ICU admission, following elective total joint arthroplasty.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

This retrospective cohort study investigated whether low preoperative hemoglobin levels increase postoperative atrial fibrillation and flutter (POAF) risk following elective total joint arthroplasty. Using the TriNetX Analytics Network Platform, we analyzed patients aged ≥ 40 years undergoing primary knee or hip arthroplasty under general anesthesia between 2010 and 2024. Patients were categorized into low hemoglobin (8-12 g/dL) and control (> 12 g/dL) groups. After 1:1 propensity score matching yielded 22,996 pairs, Cox regression analysis revealed significantly higher six-month POAF incidence in the low hemoglobin group (1.4% vs. 0.97%; HR 1.39, 95% CI 1.17-1.65, p < 0.001). The low hemoglobin group also demonstrated increased all-cause mortality (1.0% vs. 0.47%; HR 2.10, p < 0.001) and ICU admissions (1.4% vs. 0.84%; HR 1.65, p < 0.001). Even mild hemoglobin reduction (10-12 g/dL) significantly elevated POAF risk (HR 1.35, p = 0.001). Temporal analysis showed peak POAF risk occurring 30-180 days postoperatively, with effects persisting up to three years. These findings establish low preoperative hemoglobin as an independent, clinically significant risk factor for POAF and adverse outcomes following orthopedic surgery, suggesting preoperative anemia correction may be a valuable intervention for improving postoperative outcomes.

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